Revenge of the blue crab cake

Samuel M. Galvagno, Theresa L. Hartsell

Research output: Chapter in Book/Report/Conference proceedingChapter


The case A 26-year-old moderately obese woman presented to the emergency department (ED) with progressive abdominal pain and nausea. She was found to have tenderness over a preexisting 4-cm-diameter umbilical hernia and was posted to the operating room (OR) for an exploratory laparotomy and repair of likely incarcerated hernia. She denied any medical problems or allergies. Despite the curious aroma of Old Bay seasoning, the patient vehemently denied having had anything to eat or drink for 2 days! “Couldn't even get out of bed! I promise!” she said. Hmmm…Her sister and several friends who had accompanied her to the ED exchanged a few anxious glances before agreeing – nothing to eat or drink within the past 48 hours. In the OR, she underwent a standard intravenous induction, followed by easy mask ventilation. Then the inevitable occurred. Before the trachea was intubated, the patient vomited copious amounts of undigested food. What a mess! Trying hard not to swear under your breath, you manage to place an endotracheal tube after aggressively suctioning and manually clearing her oropharynx. Hoping that the worst of it is over, you patiently wait for the beep of the pulse oximeter to return to normal. Unfortunately, her SpO2remains in the 85% to 90% range, despite now being on 100% oxygen and increased positive end-expiratory pressure (PEEP). You call for a bronchoscope and take a look; you see large amounts of particulate matter, clearly recognizable as…crab cake?.

Original languageEnglish (US)
Title of host publicationCore Clinical Competencies in Anesthesiology
Subtitle of host publicationA Case-Based Approach
PublisherCambridge University Press
Number of pages9
ISBN (Electronic)9780511730092
ISBN (Print)9780521144131
StatePublished - Jan 1 2010
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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